Abstract
Accurate and scalable gait assessment is essential for clinical and research applications, including fall risk evaluation, rehabilitation monitoring, and early detection of neurodegenerative diseases. While electronic walkways remain the clinical gold standard, their high cost and limited portability restrict widespread use. Wearable inertial measurement units (IMUs) and markerless depth cameras have emerged as promising alternatives; however, prior studies have typically assessed these systems under tightly controlled conditions, with single participants in view, limited marker sets, and without direct cross-technology comparisons. This study addresses these gaps by simultaneously evaluating three sensing technologies-APDM wearable IMUs (tested in two separate configurations: foot-mounted and lumbar-mounted) and the Azure Kinect depth camera-against ProtoKinetics Zeno™ Walkway Gait Analysis System in a realistic clinical environment where multiple individuals were present in the camera's field of view. Gait data from 20 older adults (mean age 70.06±9.45 years) performing Single-Task and Dual-Task walking trials were synchronously captured using custom hardware for precise temporal alignment. Eleven gait markers spanning macro, micro-temporal, micro-spatial, and spatiotemporal domains were compared using mean absolute error (MAE), Pearson correlation (r), and Bland-Altman analysis. Foot-mounted IMUs demonstrated the highest accuracy (MAE =0.00-6.12, r=0.92-1.00), followed closely by the Azure Kinect (MAE =0.01-6.07, r=0.68-0.98). Lumbar-mounted IMUs showed consistently lower agreement with the reference system. These findings provide the first comprehensive comparison of wearable and depth-sensing technologies with a clinical gold standard under real-world conditions and across an extensive set of gait markers. The results establish a foundation for deploying scalable, low-cost gait assessment systems in diverse healthcare contexts, supporting early detection, mobility monitoring, and rehabilitation outcomes across multiple patient populations.